The incidence rate of type 2 diabetes has been increasing in the United States for the past 40 years.  In fact, the American Diabetes Association estimates that at least half of all US adults (over 65 million people) have pre-diabetes or full-blown diabetes.  It is often underreported on death certificates, and is probably the third leading cause of premature death in the US.

So why is there such an increase in diabetes in this country?  The biggest reason is diet.

From a young age, children are eating processed food. When they enter school – lunchrooms in many school districts are sponsored with food from McDonald’s, Pizza Hut, and Coca Cola.  In college – most dorm food is also like fast food, and they can eat as much as they want. That and their foray into alcohol, and we have the beginnings of obesity, insulin resistance, and pancreatic damage. The very concept of type 2 diabetes used to be called “adult diabetes”.  Since many teenagers are now diagnosed, it’s now time to change the name.

One would say that if diabetes is a disease of the foods that you eat, then simply change the foods you eat. Not that simple. Once you’re diagnosed with diabetes, you become a ward of the medical system. Doctors will perform a lot of tests, take blood, and prescribe both insulin and drugs to mimic the glucose-lowering effects of the body, and many spend a minimal amount of time counseling on the right type of diet for your needs.

There are, in fact, many good diets to lower blood sugar, like the well-known Keto diet, which emphasizes higher fats and low carbohydrates. This is something that doctors have been prescribing in one form or another since the Atkins diet in the 1960s. What about vegetarian and vegan diets?  If you ask Dr. John McDougall, one of the nation’s leading plant-based doctors, he would advocate that a diet higher in plant-based carbohydrates is better for the body than high amounts of meat and cooking oils.

Both may have a point, but if you look at the food choices that most Americans have, they walk into a grocery store, and if they’re not savvy enough to shop on the outside isles (fruits, vegetables, meats, cheeses), they are trapped in an endless cycle of boxed cereals, candy bars, frozen foods, soft drinks and alcohol. It is almost impossible to go to a store and not pick up about 50-75% of food from a box, bucket or bottle.  Many still haven’t put two and two together — that the foods they eat now will have an effect on their physiology and medical status in 5-20 years.

So what’s missing? I have been in an interesting position of working in diabetes research in the 1980s, and watching from the sidelines the work, research, and policy in this area of medical care for the past 30 years. Here are my thoughts.  

First, although exercise is touted as part of the trilogy of treatment for diabetes (along with diet and insulin), it is the first to be discarded for another type of treatment that is expedient and profitable.  

Second, there are little, if any, referrals to the health club sector in order to work on basic exercise programs for persons with diabetes. Even moderate types of programming will results in dramatic drops in body weight (and fat), daily blood sugars, and A1c levels. It simply is not being done. Many in allied health scream that personal trainers and fitness instructors are not qualified to teach exercise programs for diabetes. With the advent of medical fitness over the past 20 years, this simply isn’t the case today. I would think that having a mechanism to get patients into health clubs through their health plan, or Medicare, or a revolving door policy with their physician group, would be an outstanding way to get more patients into the exercise routine.  

Third, people who work in the fitness industry should be looking very carefully in getting diabetic persons into their facilities in their communities. This takes an effort with health club trainers, club managers and company owners to reach out to the medical community through health programs, lectures, fairs and membership discounts in order to get patients in the door.  It may even entail home exercise visits, or online coaching where patients are taught programs, and keep their exercise routines times and exercise notes. 

Lastly, the fitness industry needs to move into the technology realm and look at the effects of exercise on patients both over 3-4 weeks, but also 3-4 years. This will be done through outcomes-based software programs that can be detailed to physicians, health plans, and sports medicine journals. Once the majority of medical fitness centers and health clubs are on board, we will see a changing of the guard in terms of what Americans think is the best type of treatment program to reduce diabetes symptoms, and look at the data of how people exercise, and how many of their health risks are being reduced by a challenging and consistent exercise program. This can be done at any age, and at almost every state of diabetes — whether they are newly diagnosed, or have basic complications that they are dealing with regarding long-standing diabetes. 

It is time to embrace exercise as part of a diabetes prevention and reduction strategy.  If not, in 20 years we will probably see the epidemic at such a high level, that a good portion of Americans will not be able to work due to their complications.  The costs to society will be even higher than they are now. It’s a risk we don’t need to take, because of the untapped market of over 31,000 health clubs in the US, there is virtually no reason not to engage in exercise. It would seem that our nation’s health depends on our next steps – literally. 

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.